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Strictures
Strictures develop post surgery usually because scar tissue grows at the surgery site. Scar tissue, sadly, is inevitable, but not all ea/tef children are affected by it. Some have their esophagus repaired and never look back. Others need a few post-op dilations early on before being able to take the surgeon’s phone number off the speed dial.
A few ea/tef children need to be dilated even years after surgery. My son is one of those. After the dozens of dilations he had early on, going in twice a year to be dilated seems pretty manageable, if not exactly fun.
How do you know when your child has a stricture? It can be immediate — whoops, she swallowed a cherry! After a few fruitless hours of trying to dislodge it, you know you have to call the surgeon. Alternatively, sometimes it happens over weeks and months, so it can be hard to pinpoint when Julia or Sam started having trouble with certain foods. And other things can cloud the picture. Colds and allergies can interfere with motility, coating the esophagus with thick mucus that makes it harder for the food to go down. You may think your child’s esophagus isn’t working very well, but when the cold passes, suddenly everything is sliding down again. Eventually, though, there can be the “aha” moment, when you realize that your child isn’t sick and isn’t eating like he used to. Time to call the surgeon.
Some doctors will want your child to have an upper g.i. study (i.e. a barium swallow) to have a look at the esophagus. This isn’t a bad idea, but these studies don’t always tell the whole story. Barium (a thick, chalky liquid visible on x-ray) is not regular food. Your child may have a stricture even though the upper g.i. study looks basically okay. You are in the best position to judge. Don’t be afraid to question your child’s doctor if you think there’s a problem that’s not being addressed.